PMID: 22571128May 11, 2012Paper

A case of coil embolization for unexpected massive bleeding caused by internal carotid artery injury

Masui. The Japanese journal of anesthesiology
Hiroko FujinoTakeshi Yokoyama

Abstract

We experienced a case of coil embolization for unexpected massive bleeding due to the injury of the internal carotid artery during surgery. A 78-year-old woman underwent right maxillectomy for a malignant tumor in the maxilla. Three hours after the start of the operation, uncontrollable bleeding occurred suddenly, with the blood loss reaching 4,600 ml in 10 minutes. Blood pressure decreased precipitously, but systolic blood pressure recovered to 90 mmHg after rapid infusion and transfusion. The bleeding point could not be identified, and hemostasis by gauze compression was tried in vain. After a large amount of fluid replacement in a short period, the hemoglobin concentration decreased to 2.5 g x dl(-1) temporarily. Angiography revealed the injury of the right internal carotid artery. Coil embolization in the internal carotid artery was performed unilaterally for hemostasis. The total blood loss amounted to 28 liters, and the patient received 2,000 ml of albumin solution, 68 units of red cell concentrates and 50 units of fresh frozen plasma in addition to 18,420 ml of lactated Ringer solution. Operation time was 17 hours and 48 minutes. Despite unexpected massive bleeding and hemodilution, maxillectomy was completed and the pat...Continue Reading

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